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Coronary artery disease
Original research article
Outcomes of ischaemic mitral regurgitation in anterior versus inferior ST elevation myocardial infarction
  1. Amgad Mentias,
  2. Mohammad Q Raza,
  3. Amr F Barakat,
  4. Elizabeth Hill,
  5. Dalia Youssef,
  6. Amar Krishnaswamy,
  7. Milind Y Desai,
  8. Brian Griffin,
  9. Stephen Ellis,
  10. Venu Menon,
  11. E Murat Tuzcu and
  12. Samir R Kapadia
  1. Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Dr Samir R Kapadia; kapadis{at}ccf.org

Abstract

Background Ischaemic mitral regurgitation (IMR) is a detrimental complication of ST elevation myocardial infarction (STEMI).

Objective We sought to determine patient characteristics and outcomes of patients with IMR with focus on anterior or inferior location of STEMI.

Methods All patients presenting with STEMI complicated by IMR to our centre who underwent primary percutaneous coronary intervention within the first 12 hours of presentation from 1995 to 2014 were included. IMR was graded from 1+ to 4+ within 3 days of index myocardial infarction by echocardiography, divided into 2 groups based on infarct location and outcomes were compared.

Results Overall, 805 patients were included. There were 302 (17.8%) patients with mitral regurgitation (MR) out of the 1700 patients with anterior STEMI while 503 (21.8%) had MR out of the 2305 patients with inferior STEMI. There was no significant difference between both groups in comorbidities, clinical presentation or door-to-balloon time (DBT; median 104 vs 106 min, p=0.5). 30-day and 1-year mortality were higher in anterior STEMI compared with inferior STEMI (14.9% vs 6.8% and 26.4% vs 14.3%, respectively, p<0.001 both), as well as 5-year mortality (39.7% vs 24.8%, p<0.01). When analysis was performed for each grade of IMR, anterior was associated with worse outcomes in every grade. On multivariate cox survival analysis, after adjustment for age, gender, comorbidities, grade of IMR, ejection fraction and DBT, anterior STEMI was still associated with worse outcomes (HR 1.62 (95% CI 1.23 to 2.12), p<0.001).

Conclusions Although IMR occurs more frequently with inferior infarction, outcomes are worse following anterior infarction.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2016-000493

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    Footnotes

    • Competing interests None declared.

    • Ethics approval Institutional Review Board (IRB) of Cleveland Clinic.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.